An AAST-MITC analysis of pancreatic trauma: Staple or sew? Resect or drain?

Introduction: Pancreatic trauma results in high morbidity and mortality, in part caused by the delay in diagnosis and subsequent organ dysfunction. Optimal operative management strategies remain unclear. We therefore sought to determine CT accuracy in diagnosing pancreatic injury and the morbidity and mortality associated with varying operative strategies.

Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures.

Background: Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear.

Objectives: The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma.

Methods: Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest.

A negative urinalysis is associated with a low likelihood of intra-abdominal injury after blunt abdominal trauma.

Background: The utility of urinalysis (UA) to diagnose intra-abdominal (IA) or genitourinary (GU) injury after blunt trauma remains controversial. The purpose of this study was to determine the significance of UA in the blunt trauma patient.

Methods: A retrospective review of patients admitted for blunt abdominal trauma from 2011 to 2013.

Association of sentinel lymph node diameter with melanoma metastasis.

Background: Lymph nodes are an important part of the immune system and the size of the lymph node reflects local immunologic activity. The purpose of this study was to examine the association between sentinel lymph node (SLN) size and the presence of nodal metastasis in patients with melanoma.

Methods: Retrospective review of a prospectively maintained database of patients undergoing SLN biopsy for cutaneous melanoma between February 1995 and January 2013.

RibScore: A novel radiographic score based on fracture pattern that predicts pneumonia, respiratory failure, and tracheostomy.

Background: There is currently no scoring system for rib fractures that relates detailed anatomic variables to patient outcomes. Our objective was to develop and validate a radiographic rib fracture scoring system based on computed tomographic chest findings.

Methods: We reviewed our trauma registry from September 2012 to April 2014 for all blunt trauma patients with one or more rib fractures visualized on chest computed tomography.

Screening for Ventilator-Associated Pneumonia in the Surgical Intensive Care Unit: A Single-Institution Analysis of 1,013 Lower Respiratory Tract Cultures.

Background: Refinement of criteria for both screening and initiation of empiric therapy in ventilator-associated pneumonia (VAP) will minimize antibiotic overuse. We hypothesized that variables within the commonly used Clinical Pulmonary Infection Score (CPIS) have unfavorable test performance characteristics.

Methods: Consecutive bronchoalveolar lavage (BAL) cultures obtained from surgical intensive care unit patients were abstracted (2009-2012).

Predictors of the necessity for early tracheostomy in patients with acute cervical spinal cord injury: a 15-year experience.

Background: The need for mechanical ventilation (MV) after spinal cord injury (SCI) is a risk factor for prolonged critical care. The "purpose" of this study was to identify the level of cervical SCI that requires MV, thereby defining candidates for tracheostomy.

Methods: Patients with cervical SCI over a 15-year period were reviewed.

Early repeat imaging is not warranted for high-grade blunt cerebrovascular injuries.

Background: The current management for blunt cerebrovascular injuries (BCVIs) includes repeat imaging 7 days to 10 days after initial diagnosis. This recommendation, however, has not been systematically evaluated. The purpose of this study was to evaluate the impact of early repeat imaging on treatment course.

Trauma remains a surgical disease from cradle to grave.

Background: A dramatic rise in nonoperative management of many blunt and some penetrating traumatic injuries has occurred during the past four decades. This trend has lead some to suggest that trauma is no longer a surgical disease. We questioned what role the trauma surgeon plays in the care of the injured patient.

A multicenter, randomized clinical trial of IV iron supplementation for anemia of traumatic critical illness*.

Objective: To evaluate the efficacy of IV iron supplementation of anemic, critically ill trauma patients.

Design: Multicenter, randomized, single-blind, placebo-controlled trial.

Setting: Four trauma ICUs.

Intra-abdominal injury following blunt trauma becomes clinically apparent within 9 hours.

Background: The diagnosis of blunt abdominal trauma can be challenging and resource intensive. Observation with serial clinical assessments plays a major role in the evaluation of these patients, but the time required for intra-abdominal injury to become clinically apparent is unknown. The purpose of this study was to determine the amount of time required for an intra-abdominal injury to become clinically apparent after blunt abdominal trauma via physical examination or commonly followed clinical values.

Endovascular stenting is rarely necessary for the management of blunt cerebrovascular injuries.

Background: The role of stenting for blunt cerebrovascular injuries (BCVI) continues to be debated, with a trend toward more endovascular stenting. With the recent intracranial stenting trial halted in favor of medical therapy, however, management of BCVI warrants reassessment. The study purpose was to determine if antithrombotic therapy, rather than stenting, was effective in post-injury patients with high-grade vascular dissections and pseudoaneurysms.

Emergency department pericardial drainage for penetrating cardiac wounds is a viable option for stabilization.

Background: Penetrating cardiac injuries (PCI) causing tamponade causes subendocardial ischemia, arrhythmias, and cardiac arrest. Pericardial drainage is an important principle, but where drainage should be performed is debated. We hypothesize that drainage in the emergency department (ED) does not delay definitive repair.

Hypercoagulability following blunt solid abdominal organ injury: when to initiate anticoagulation.

Background: The optimal time to initiate venous thromboembolism pharmacoprophylaxis after blunt abdominal solid organ injury is unknown.

Methods: Postinjury coagulation status was characterized using thromboelastography (TEG) in trauma patients with blunt abdominal solid organ injuries; TEG was divided into 12-hour intervals up to 72 hours.

Results: Forty-two of 304 patients (13.

A negative urinalysis rules out catheter-associated urinary tract infection in trauma patients in the intensive care unit.

Background: Urinary tract infection (UTI) in trauma patients is associated with increased mortality. Whether the urinalysis (UA) is an adequate test for a urinary source of fever in the ICU trauma patient has not been demonstrated. We hypothesized that the UA is a valuable screen for UTI in the febrile, critically ill trauma patient.

Long-term follow-up and survival of patients following a recurrence of melanoma after a negative sentinel lymph node biopsy result.

Objective: To analyze the predictors and patterns of recurrence of melanoma in patients with a negative sentinel lymph node biopsy result.

Design: Retrospective chart review of a prospectively created database of patients with cutaneous melanoma. SETTING Tertiary university hospital.

Perioperative management of peripheral vascular trauma.

Peripheral vascular trauma is not uncommon in the civilian setting, and it can be uniquely challenging because of the limited time during which intervention can salvage an ischemic extremity. Injuries can be from a blunt or penetrating mechanism, and these injuries can be isolated or can be in the setting of a complex multisystem trauma. The intent of this review is to discuss the perioperative management of peripheral vascular trauma with an emphasis of predicting, preventing, and managing common postoperative complications.